Monthly Matters:

• Team GreenField Rides in the ADA Tour de Cure
• Healthcare Reform
• Flu Vaccine Preparations Underway
• Family Matters: Seafood Watch
• Office Notes

GreenField Health’s Health Matters

August 2009

Team GreenField Rides in the ADA Tour de Cure

A team from GreenField Health participated in the American Diabetes Association’s Tour de Cure this year on Saturday, July 25th. The bike ride started and ended at the Hillsboro stadium and went through twenty-seven miles of beautiful farmland in Hillsboro. The GreenField riders all came decked out in their bike helmets, sun glasses, and bike attire to brave the heat. They raised over $2,400 to support diabetes research!

There are an estimated 23.6 million children and adults in the United States who have diabetes, approximately 7.8% of our population. GreenField supports efforts to improve treatments and perhaps even find cures for this common condition.

Healthcare Reform

Discussions about healthcare reform are everywhere these days – on the radio and TV, over the kitchen table, at restaurants, on blogs, in newspapers, at work and more. Almost everyone has an opinion and much of what is being stated about current proposals is frankly not true and intentionally deceptive. Instead of seeking understanding and solutions, some simply spread fear and resistance to meaningful reform. Unfortunately, this is highly detrimental as it impairs our collective ability to achieve meaningful reform of our very broken, ridiculously expensive healthcare system.

Earlier this month, Dr. Chuck Kilo attended an invitational working meeting of healthcare leaders and health policy experts focused on healthcare reform sponsored by the American Board of Internal Medicine Foundation. The challenges of fixing US healthcare are many, but fix it we must because individuals, families, our communities, employers, and our economy are being hurt by the high cost of US healthcare.

Instead of trying to explain healthcare reform, we’ve decided to allow Dr. Uwe Reinhardt to do so for us. Dr. Reinhardt is an economics professor at Princeton University, one of the most knowledgeable international health policy experts, and a shrewd observer of US healthcare. Here is a recent summary from Dr. Reinhardt, responding to a Wall Street Journal column:

A ‘Common Sense’ American Health Reform Plan
By Uwe E. Reinhardt, July 31, 2009

“Common Sense May Sink ObamaCare” was the title of Peggy Noonan’s recent Wall Street Journal column. She wrote: It turns out the president misjudged the nation’s mood. … I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense.

Ms. Noonan is right.

After studying this nation’s perpetual “national conversation” on health reform for over three decades now, I am firmly convinced that any health reform that is the product of logical cerebral processes automatically misjudges what Americans appear to see as “simple common sense” in health care. The president’s plan does so, as would have been the case with Senator John McCain’s radical reform proposal as a presidential candidate, or Senators Ron Wyden and Robert Bennett’s “Healthy Americans Act” (S. 334).

Here is just a short list of the design parameters that an acceptable health reform proposal would have to incorporate to conform to the American public’s idea of “common sense” in health care. (In utter frustration, I had earlier submitted a similar but shorter list, in transmitting the final report of the New Jersey Commission on Rationalizing Health Care Resources to Gov. Jon Corzine.)

The All-American Wish List for Health Reform

1. Only patients and their own doctors should decide what clinical response is appropriate for a given medical condition, even if that response involves unproven clinical procedures or technology.

2. Neither government bureaucrats nor private insurance bureaucrats should ever refuse to pay for whatever patients and their doctors have decided to do in response to a given medical condition. An insurer’s refusal to pay for a medical procedure is tantamount to rationing health care.

3. Rationing health care is un-American.

4. Cost-effectiveness analysis should never be the basis of any coverage decision by public or private third-party payers in health care, for to do so would put a price on human life — which, in America, unlike everywhere else, is priceless.

5. Government should not require individuals to purchase health insurance. Such a mandate would violate the constitutional rights of freedom-loving Americans.

6. Americans have a moral right to life-saving and potentially highly expensive medical care, should they fall critically ill, even if they are uninsured and could not possibly pay for that care with their own financial resources. (Why else would God have created hospitals and their emergency rooms?)

7. Government should stay out of health care. Specifically, government should not control health care prices, nor should it increase its spending on health care, which is out of control.

8. Even small reductions to the future growth of Medicare spending — called “cuts” in Washington parlance — unfairly burden the elderly, along with the doctors and hospitals that serve them and the manufacturers of health products, lest the pace of technical innovation be impaired.
   

And so on, and so forth. Any health policy analyst over the age of 40 could easily double the list. It might make for a good parlor game at a bar.

Readers may believe I am jesting. But follow the editorial pages or punditry, especially of the conservative news media, over some time.

You will hear or see regular rants there against the idea that “costs” or “cost-effectiveness analysis” should ever be brought to bear on what public insurance programs would or would not pay for. The Washington Times went so far as to adorn one of its editorials on the subject with a picture of Adolf Hitler. By now, the extreme right has persuaded many Americans that the hidden agenda of the president’s health reform is to introduce euthanasia into America.

The editorial page of The Wall Street Journal regularly berates the idea of ever letting costs enter coverage decisions in Medicare and Medicaid. It decries attempts by government to curb Medicare spending as a “cost shift” from government (said to underpay doctors and hospitals) to private insurers — who are said to be able to control health spending better than government, but somehow cannot resist this alleged cost shift and therefore obediently pay doctors and hospitals higher prices. Finally, the editorial page regularly rants about rising government spending on health care.

It all is simple common sense, don’t you see?

To be responsive, then, to the “simple common sense” of the American people, any proposed health reform must not reduce the revenue of hospitals, lest some neighborhood hospital may have to close; or of doctors, lest some doctors might refuse to see patients; or of the manufacturers of health products, lest they are unable to innovate; or of anyone on the supply side of the health sector, lest they go out of business and have to lay off employees.

At the same time, the “simple common sense” of the American people dictates that any health reform that fails to bend down the growth curve of future health spending — the current jargon for controlling health spending better — is unacceptable, too.

Why? Because currently projected health spending will chew up 40 percent or more of the nation’s economy by 2050, American governments at all levels will go broke, and American companies will be uncompetitive in the global marketplace or slide into bankruptcy, like General Motors.

Finally, “simple common sense” dictates the sole and proper perspective any American citizen should have on health reform is this fundamental question: “What does the reform mean for me?”

Highly symbolic of that posture was a question addressed to President Obama by Pastor David Hattenfield, of Cornerstone Baptist Church, in Cumberland, Md., during a recent ABC News town hall meeting at the White House.

Queried the man of God:

With the — with the cost of health care, you know, I’m pretty satisfied with my own plan. It’s not everything that it should be or could be, but I am concerned that — of the government taking over health care. And, you know, Social Security isn’t — isn’t doing real well. At least that’s what we’re being told. And how can we know that the government is going to be able to handle the cost of health care? Isn’t that going to tax me? Isn’t it going to be taxing my benefits, those kind of things?

It so reminded me of Ron Barrett’s marvelous rendering of our nouveau psyche in Jan Hoffman’s article “Here’s Looking at Me, Kid”.

Ron Barrett: To be acceptable in America, health reform should not create winners or losers, but only winners. It is de minimis.

Your homework assignment, dear reader, is to design such a plan.

Flu Vaccine Preparations Underway

While the yearly influenza (flu) vaccine is being prepared at present, trials of the vaccine against the new H1N1 pandemic virus, the so called “swine flu,” are also underway. Yes, there will be two influenza vaccines this year.

Influenza season typically starts in late October or November and there should be plenty of the standard vaccine. However, supplies of the H1N1 pandemic vaccine will likely be more limited due to limitations in the capacity of vaccine makers. The Centers for Disease Control recently recommended that H1N1 pandemic flu vaccine be made available first to the following five groups:

- Pregnant women
- Health care workers and emergency medical responders
- People caring for infants under 6 months of age
- Children and young adults from 6 months to 24 years
- People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes)

Combined, these groups would equal approximately 159 million individuals. In fact, it may be some time before enough vaccine is available to target even these groups much less the entire population. These groups are seen as the highest priority because they seem to be the most vulnerable to the new virus and the most likely to encounter it —younger people, pregnant women, healthcare personnel, and people who have underlying health conditions. Thus, the list of priorities is different for the two vaccines.

GreenField will certainly have a sufficient supply of the traditional flu vaccine, but how the H1N1 pandemic flu vaccine will be distributed for administration is itself not yet clear. However, given the complexity of these issues, the speed with which the government, public health authorities, and vaccine manufactures are addressing them is impressive and deserves commendation.

As the time draws near, you will continue to hear reports about this topic on the news, and we’ll keep you updated in these pages of our monthly GreenField Health’s Health Matters.

Family Matters: Seafood Watch

As just about everyone knows, fish is a helpful part of a healthy diet. Fish is a great substitute for meat and has great health benefits if consumed regularly. However, since the world has well over 6 billion inhabitants now, quickly approaching 7 billion, our oceans and global fish supplies are suffering. While oceans cover nearly 70% of the earth’s surface, the human impact on our oceans has been profound.

Due to over-fishing and other bad fishing practices, many fisheries around the world have collapsed leaving our oceans and fish in peril. For example, cod fish off of the coast of New England in an area called George’s Bank used to be so plentiful fisherman said you could walk on them. However, in the 1990s, George’s Bank was declared dead from over-fishing – the cod population had been completely decimated. This is but one example of the negative effect humans can have on our oceans and global fish stocks if they are not properly managed.

So what does this mean for you? Fish consumption is good for you, but buying fish can support poor environmental practices. To make things worse, due to environmental pollutants, some fish meat contains unsafe levels of toxins making them less healthy to consume.

Fortunately, scientists working with the Monterey Bay Aquarium have created a guide to help you understand which fish are best to eat. You can find more information at www.montereybayaquarium.org/cr/seafoodwatch.aspx. The Monterey Seafood Pocket Guide lists which fish are acceptable to consume based on the health of the fish species population, harvesting practices, and contaminants in the fish themselves. It is available at www.montereybayaquarium.org/cr/cr_seafoodwatch/download.aspx.  

The Seafood Watch West Coast Pocket Guide can also be obtained at New Seasons Markets – you can keep it with you and pull it out when you are ordering at a restaurant or purchasing food at the market. If the restaurant doesn’t seem to be aware of which fish are best for them to serve, you can give them a pocket guide and ask that they consider keeping their menu consistent with the recommendations. We also find the Pocket Guides to be a great conversation starter about sustainable food practices. Bon Appetit!

Office Notes

• Labor Day Holiday – We will be observing Labor Day, and the office will be closed on Monday, September 7th. As always, a GreenField physician is available to you for urgent or emergent needs by calling our main number (503) 292-9560.
  

• GreenField's eStatements - Saving Time, Money & Paper
  We are entering our second month of e-statements. We have made several adjustments to streamline the process of paying your bill online based on feedback that we have heard from several of you. As a reminder, here is how our new e-Statements work:
• You will receive a secure email when you have a statement or new bill from us. (This means we’ve billed your insurance, and they’ve paid, so this is the actual part that you owe.)
• If it goes unopened, after 5 days, the system will send you another secure email notification that you have not opened your statement.
• The system will automatically drop the statement to paper and mail it to you, if neither of the emails are opened after a period of time, which will be approximately 2 weeks.

Paying your bill online should be quick and easy. Simply follow the link in your statement to log on to the Bill Pay site. If this is your first time, you will need to register with them. We welcome your feedback, questions and concerns about our new e-statements. Please email your feedback to Beth.Davis@GreenFieldHealth.com.

As we begin to approach the end of summer, and start to think about the fall season and sending our little ones off to another year of school, we wish you all a happy and healthy start to the fall months and the new school year.

Sincerely,

Your GreenField Team

Alisyn Shaw, CMA, your Health Coordinator (email)
Angie Ashburn, CMA, your Health Coordinator (email)
Beth Davis, your Business Office Manager (email)
Bonnie Hicks, your Billing Clerk (email)
Carrie Destefano, CMA, your Health Coordinator (email)
Chuck Kilo, MD (email)
Connie Turner, MA, your Health Coordinator (email)
Cynthia Ferrier, MD (email)
Dana Lee, MA, your Clinical Supervisor (email)
Danika Pellicano, NCMA, your Health Coordinator (email)
David Hays, MD (email)
David Shute, MD (email)
Elizabeth Hays, MD (email)
Jill Arena, your COO (email)
Joel Swartzmiller, your IT Manager (email)
Kate Griggs, your Administrative Assistant (email)
Kim Walgraeve, your Marketing Manager (email)
Kristin Walker, your Program and Executive Assistant (email)
Malcolm McAninch, MD (email)
Marsha Box, MA, your Health Coordinator (email)
Meena Mital, MD (email)
Pam Mockenhaupt, CMA, your Health Coordinator and Biller (email)
Paula Koeller, MD (email)
Peter Casey, your Consultant (email)
Samantha Charles, your Clinic Administrator (email)
Todd Canon, MD, (email)

GreenField Health at Barnes Road
9427 SW Barnes Road, Suite 590
Portland, OR 97225

GreenField Health at NE Broadway
2606 NE Broadway, Suite C
Portland, OR 97232

Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.GreenFieldHealth.com

questions, concerns, comments always appreciated:
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